Respiratory Cases (DSA and CIS) Flashcards
how is the diagnosis of acute otitis media made (3 things)
acute onset of symptoms
evidence of middle ear effusion
signs and symptoms of middle ear inflammation
AOM that is recurring or that has treatment failure often is most likely associated with what?
S. pneumonia
how do you treat initial episodes of nonsevere AOM
high dose Amoxicillin
what do you use pharm wise for initial therapy in pt’s with SEVERE AOM
amoxicillin-clavulanate
when are tympanostomy tubes appropriate?
children who have persistent OME as well as for those who have risk factors for developmental delay or evidence of damage to the middle ear
what is the difference b/w AOM and OME
OME describes the presence of middle ear effusion without signs or symtpoms of infection
AOM = acute otitis media
infection of the middle ear with acute onset of signs and symptoms, MEE, and signs and acute symtpoms of middle ear inflammation
what is treatment failure AOM
lack of improvement within 48-72 hrs after initiation of antibiotic therapy
what is recurrent AOM
3 or more AOM episodes occurring in the previous 6 months or four or more AOM episodes in the preceding 12 months
what is the initial mechanism that triggers otitis media
impaired eustachian tube function such as occurs during
ACUTE:
URI, Gastroesophageal reflux, allergic rhinits
chronic:
- craniofacial anomalies (Cleft palate)
- shorter eustachian tubes of younger children
what is the most important predictor of AOM complicating a URI
Young age
what are the most common viruses involved in AOM
RSV
parainfluenza
influenza (A and B)
coronavirus
what are the most common bacterial infections associated with AOM
strep pneumoniae
H. influenzae
Moraxella Catarrhalis
S. pyogenes
what is tympanometry
measures the compliance of the TM
put the device in the ear and make air tight seal
the device transmits sound waves reflecting off theTM
energy reflected by these sounds waves is a measure of TM compliance
B curve- flat, meaning poor or no mobility and is usually associated with MEE (OME or AOM)
C- curve- near normal compliance, but the peak shifted towards negative pressures due to increasing negative pressures in the middle ear, generally a precursor to an effusion
which children are candidates for watchful waiting and skippin the antibiotics unless the pt worsens?
otherwise healthy children 6 months to 2 years of age with nonsevere illness at presentation and an uncertain diagnosis
AND
children 2 years of age and older without severe symptoms at presentation
OR
with uncertain diagnosis
how does OMT help with AOM?
a standard OMT protocol administered adjunctively with standard care for pt’s with AOM resulted in faster resolution of MEE at 2 weeks than standard care alone
what is the galbreath technique
simple mandibular manipulation that helps the middle ear drain and leads to quicker resolution of the problem
manipulating the mandible –> the physician increases blood flow to and through the region by alternately compressing and releasing the pterygoid plexus of veins and lymphatics in the region
with the pt sitting in the physicians lap, the pt’s “bad” ear is away from the physician and the doc uses his opposite hand (so if the pt’s right ear, then use docs left hand) and apply a downward and transverse force on the mandible that crosses the face
what is the difference b/w respiration and breathing ?
breathing –> move air from outside the body into the lungs, exchange oxygen in the air for carbon dioxide in the blood stream, and then exhale the air
respiration–> provide for a similar exchange of these gases at the cellular level
which dominates in the lungs:
parasympathetic or sympathetic
parasympathetic
facilitation level of lungs
T1-6
chapman’s point for heart
(myocardium)
Anterior:
2nd ICS close to the sternum on the right?
Posterior:
intertransverse space midway b/w spinous and transverse process of the 2nd and 3rd thoracic vertebrae
upper lung chapman’s points
3rd ICS (b/w 3rd and 4th ribs) close to sternum anteriorly
posterior:
intertransverse space ,midway b/w spinous and transverse process of the 3rd and 4th thoracic vertebrae
lower lung chapman’s point
Posterior:
intertransverse space ,midway b/w spinous and transverse process of the 4th and 5th vertebrae
Anterior 4th ICS (b/w 4th and 5th ribs)
what are the hypersympathetic effects in the lung?
dilation of the bronchial tubes
epithelial hyperplasia –> goblet cells in the bronchial epithelium increase = more mucus that is thin watery
Sinus decongestion
what is the outcome of having a flat diaphragm
decrease in pressure b/w the thorax and abd cavity–> decreased lymph flow increases congestion of tissues and can decrease CO
initial manipulative treatment in pneumonia has what three main goals?
reduce congestion
reduce sympathetic hyperactivity to the parenchyma of the lung
reduce mechanical impediments to the thoracic cage respiratory motions
what are some techniques used for the treatment of pneumonia
rib raising - focus on T1-T6–> helps make a more thin secretion
thoracic inlet - MFR
thoracolumbar area treatment
Diaphragm
exhaled rib dysfunction is most frequently caused by what?
coughing
treatment of the OA or AA makes patients more comfortable and normalize what?
parasympathetic influence to the lungs through the vagus
what is included in the osteopathic manipulation plan for pt’s with lower pulmonary dysfunction
cervicals C3-C5 (phrenic n.)
sternum
T1-T12 and ribs 1-12
thoracolumbar junction
Sympathetics:
Rib raising T1-6
Chapmans
Lymphatics: Thoracic inlet Abd diaphragm Rib raising Lymphatic pumps
Parasympathetics:
-OA,AA, cranial- vagus
T1-2
upper airway, head
Superior cervical ganglion- anterior to CV1 and CV2
Stellate ganglion (= inferior cervical and 1st thoracic)
T2-6
= bronchioles, lungs
Superior cervical ganglion
fused ganglia of C1 through C4
provides postganglionic innervation to the head and neck
stellate ganglion
fusion of the inferior cervical sympathetic ganglion with the ganglion of T1
middle cervical and stellate ganglia innervate the heart, lungs, and bronchi
where is parasympathetic innervation of the lungs and upper airways from?
vagus
Pterygopalatine (Sphenopalatine) ganglia supplies what?
parasympathetic innervation to the sinuses, nose, lacrimal gland, and blood flow to the nasal mucosa.
by treating this you reduce congestion
what does sympathetic stimulation cause in the airways
Response tends to be more general
Mucous glands and blood vessels are heavily innervated by the sympathetic nervous system
Smooth muscles are not
Stimulation of the sympathetic nerves in the mucous glands increases water secretion and
Decreases the viscosity of mucus.
Stimulation of the sympathetic system causes
Airway relaxation
Blood vessel constriction
Inhibition of glandular secretion
Increased release of water, which lowers the viscosity of mucus
what does parasympathetic stimulation in the airways cause
slightly constricted smooth muscle tone in the normal resting lung
innervation is greater in the larger airways, and it diminishes toward the smaller conducting airways in the periphery
bronchial glands, increases the synthesis of mucus glycoprotein and
increases the viscosity of mucus
Stimulation of the parasympathetic system leads to
Airway constriction
Blood vessel dilation
Increased glandular secretion
Increased synthesis of mucus glycoprotein, which raises the viscosity of mucus
what are muscles that work during inspiration
external intercostal
what muscles are involved in expiration
internal and innermost intercostals
subcostals
transversus thoracis
what is the effect of kyphosis on mechanical ventilation
Reduction of thoracic kyphotic angles demonstrated a reduced vital capacity, inspiratory capacity, total lung capacity, and lateral expansion (P<0.05).
There is also a significant negative correlation between the increased kyphotic angle and inspiratory capacity, vital capacity, and lateral expansion of the thorax.
what are anterior chapman’s points for
diagnosis
posterior chapmans points are for what
treatment
bronchus chapmans points
(esophagus and thyroid): between ribs 2 and 3 close to the sternum
bronchus: midway between the tip of the transverse process and spinous process of T2 on the posterior aspect of the transverse process
nose chapman’s
costochondral junction of 1st rib
nose: lateral aspect of the transverse process of C1
tonsils chapmans
between 1st and 2nd ribs (1st intercostal space) close to the sternum
tonsils: posterior surface of C1 transverse process, midway between the nuchal ligament and lateral most aspect of the C1 transverse process
sinuses chapmans’
3 ½” from the sternum, on the upper edge of 2nd rib and in the 1st intercostal space
sinuses: midway between the tip of the transverse and spinous processes of C2 on the posterior aspect of the transverse process
middle ear chapmans
upper edge of the clavicle, just lateral where it crosses the 1st rib
middle ear: (otitis media) upper edge of the posterior aspect of the tip of C1 transverse process
pharynx chapmans
front of 1st rib ¾-1” medial to where the clavicle crosses the1st rib
pharynx: midway between the spinous process and tip of the transverse process of C2, on the posterior aspect of the transverse process
larynx chapmans
upper surface of 2nd rib, 2-3” lateral from the sternum
larynx: midway between the tip of the transverse process and spinous process of C2 on the posterior aspect of the transverse process
tongue chapman’s
Tongue – front of 2nd rib cartilage ¾” from the sternum
what is the purpose of the galbreath technique
Purpose – to increase blood flow through the pterygoid plexus of veins and lymphatics, drainage of the Eustachian tube, stretching of the peri-pharyngeal muscles and fascia
Patient supine (or seated in treating physician’s lap) Affected side down (or away from physician’s treating hand) Grasp mandible of affected side Draw mandible downward and transversely with mild force for 3-5 seconds, repeating for 30-60 seconds
vomer
sits where in the skull?
motion?
direction of movement?
The vomer is a midline bone that sits above the inter-maxillary (palatine) suture. Its motion is flexion and extension as it is driven by the motion of sphenoid.
The vomer moves in a postero-inferior direction during flexion and the opposite motion in extension.
It would be particularly obnoxious to palpate the vomer directly (deep to the soft palate).
Palpation is done at the cruciate ligament.
You can self-treat by placing your thumb pad over the cruciate ligament.
Gently resting your head on the thumb and your elbow on the table.
Wait for several cycles of flexion and extension for the vomer to be encouraged to resume its usual motion.
what is the function of the vertebropleural ligament
and restriction of this can cause what!
The function of this “ligament” is to ensure that each lung is
equally aerated much like guide ropes on a hot air balloon.
Restriction here can limit lung function and C7 motion.
somatic dysfunction of the thoracolumbar junction (especially flexed segments T10-L2) can cause what
increased sympathetic tone to the adrenal glands which can lead to weakening of the immune system if chronically present. Can also impair toxin excretion via the kidneys and intestines with chronic somatic dysfunction.
what are the contraindications in treatment of resp problems in patients
1) No forceful direct treatments (depending on severity of illness)
2) HVLA to the thoracic spine relatively contra-indicated due to initial increase in sympathetic activity
3) Do not overtreat and tire the patient
4) Do not use treatment positions that aggravate patient’s breathing or pain (relative caution)
5) Thoracic pump technique in COPD patients
6) Visceral techniques in the acute phase
